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One Child's Experience with Cerebral Palsy

This is a question I was asked by the parent of a two year old with cerebral palsy. I felt that my answer may help provide an understanding of my work and for that reason was worth sharing.

My son's arm remains bent and may be preventing him from progressing further.  He is starting to have an idea how to use it but it is preventing him from having true mobility - he can not weight bear on his arms, or roll over completely - anything that requires the right arm to be fully extended will be limited.

What options are there for working with his arm?  Can you help him learn to extend it?

It is possible that Andrew's arm is structurally incapable of straightening.  Based on your description it doesn't sound like this is the case, but even it was, it doesn't need to be a block to further progress.  Even if it was permanently bent he could still learn to roll over and to support himself with it.

A lot of the action of rolling over is related to the mobility of the shoulder, ribs, back and pelvis.  Also, if he was able to rotate his upper body sufficiently he could lean on the elbow on the right side and his hand on the left side.  (You might have to try this for yourself to understand what I mean.  You might also try rolling over while keeping your arm bent and you will probably find that you can do it.)

The goal may well be for him to straighten his arm but in reality the end goal is more than this - we want him to function at his highest possible level.  My approach would be to find out what he can almost do or can only just do, and work to increase that skill.  Along with that I would look to have him know that he is doing it of his own intention rather than just randomly.  In other words I would help him develop a skill, and then use it with intention.

This action could then be combined with other actions to build greater and greater function.  As his overall function increases I would expect to see the function of individual pieces increase (such as the use of the arm for example).

Since I haven't seen him, I don't know what the next step is for Andrew but for the purposes of illustration I will assume that it is rolling over, and I will assume that the bent arm is a limitation.  If he were to learn to roll over in the direction that was not inhibited by the bent arm and it was worth his while, then he would have a skill base and a motivation to learn to roll the other way.  By "worth his while" I mean that he might get something he likes when he rolls over such as a kiss, or a noise that makes him laugh, or a toy - anything that gives him a reason to roll.  To be "worth his while", it would also have to be easy for him (babies don't do things unless they are easy - the doing it by willpower thing is something we learn later in life).

In order to learn to roll over he may well have to first learn to move his back, pelvis, ribs, hips and head in more refined ways and to learn the relationships between them.  This is the basis of any lesson - the practitioner looks for something that can be improved and then looks to link it to other areas and then give it some kind of context that will give a reason for the student (aka Andrew) to adopt it as a new action.  For example, his ribs on one side may not move very well, so some work can be done to make them more mobile.  Then he can be shown why his ribs should be mobile, maybe by linking their mobility to twisting in the spine.  Then he could be taught why twisting the spine is good - maybe to make it easier for him to turn his head to see something or to reach for a toy.

We are using movement but we are really working with the brain.  The job of the brain is to put order into disorder and to make sense out of nonsense.  Being unaware of parts of the body or not knowing how to use them is basically disorder and nonsense.  As awareness and use improve, the brain learns how to put things in order and to make sense of things.  It might do this in the context of moving a rib to begin with, but then the brain's skill at organizing and making sense will improve and order will come to other things.  We are looking to help the brain to right itself and this is often done by working in a way that does not look intuitive to the outsider but does make sense to the child's brain.

As Andrew learns to make more sense of his world, and to learn to take action based on his intention, his bent arm will become much less important and probably even irrelevant.  It will either start working as it "should" or will not be a limitation on him making progress in the world.